MedWire News: Transcatheter aortic valve replacement (TAVR) substantially increases life expectancy in patients with inoperable aortic stenosis at costs that fall within current limits, an analysis of the PARTNER study indicates.
The study included all 358 patients from Cohort B of the PARTNER trial. In these patients, who had severe, symptomatic, inoperable aortic stenosis, TAVR was compared with standard care. The study included an in-trial analysis of observed survival, quality of life, and resource utilization, as well as projected lifetime survival and costs.
TAVR was associated with substantially higher 1-year costs than standard care, but lower follow-up costs, and a projected 1.9-year increase in life expectancy.
At an incremental cost difference of US$79,837 (€56,166) between TAVR and standard care, and an incremental life expectancy of 1.59 years, the incremental cost-effectiveness ratio for TAVR versus standard care was US$50,212 (€35,325) per life-year gained. The results were only minimally affected by major sensitivity analyses.
"Our perspective is that the costs of this intervention, even in this elderly and extremely high-risk population, are justified by the very significant benefits, and that the ratio of costs to benefits stacks up well compared with other therapies the US healthcare system pays for today," said lead investigator, Matthew Reynolds (Harvard Medical School, Boston, Massachusetts, USA).
Cohort B of the Placement of AoRTic traNscathetER valve (PARTNER) trial involved patients randomly assigned to undergo transfemoral TAVR or standard therapy (179 patients in each group), who were followed-up for 1 year. The average age of the patients was 83 years, and mean Society of Thoracic Surgeon Risk Scores were 11.2 and 12.2 in the TAVR and standard therapy groups, respectively.
The current analysis assessed costs for index admission, follow-up hospitalizations, and resource-based costs. In addition, parametric survival models were used to extrapolate patient-level life expectancy beyond the study period, and the EQ-5D questionnaire was administered at baseline and 1, 6, and 12 months as the basis for determining quality-adjusted life years (QALYs).
The calculated costs for the last 6 months for surviving patients was used to project future costs beyond 12 months, and all future costs, life years, and QALYs were discounted at 3%, which is consistent with current guidelines.
The admission costs for TAVR were US$78,540 (€55,254), the largest proportion of which was due to procedural costs, with the commercial cost of the valve estimated at US$30,000 (€21,105). Twelve-month follow-up costs were significantly lower for TAVR than for standard care, at US$29,352 (€20,650) versus US$52,724 (€37,092), respectively (a difference of US$23,372 [€16,443]; p<0.001).
Life expectancy during the trial was 0.53 years less in the standard-care group, while projected life expectancy among survivors was higher for TAVR, at 3.11 years versus 1.23 years in the standard care group (a difference of 1.88 years).
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